Paediatric kidney transplantation: Towards a framework for pretransplant urological evaluation

Abstract

The role of the urologist in paediatric kidney transplantation has evolved alongside advances in management for the various causes of end‐stage kidney disease. Improvements in antenatal intervention and postnatal care have seen children with increasingly complex urological anomalies survive until transplant. Once solely responsible for the oversight of a child's surgical care, the paediatric urologist now works within a multidisciplinary transplant team, alongside transplant surgeons, paediatric nephrologists, transplant coordinators, psychologists, social workers, and transitional care specialists. We sought to identify available pretransplant evaluation frameworks to guide urological preparation and decision‐making. Drawing from available evidence and reflecting on multi‐institutional experience, we propose a streamlined approach to urologic assessment, which recognises that optimal transplant outcomes in this heterogenous cohort require lower urinary tract dysfunction to be carefully defined preoperatively.

Urodynamics in the Transplant Population

“…Over the years, research has demonstrated no significant difference in long-term graft survivability for patients with CAKUT, including those who have undergone urinary tract reconstruction [29][30][31][32]. However, this is in part due to a thorough pre-transplant evaluation that ensures the graft is being transplanted into a low pressure LUT system that empties efficiently [33].…”

“…According to Evans-Barns et al, UDS is widely incorporated in the initial work-up of pediatric candidates with maintained urine output to ensure adequate bladder function prior to KT [33]. In any patients with known or suspected CAKUT, fluoroscopic UDS should be performed to identify any need for optimizing interventions prior to KT, which can improve long-term graft outcomes [34].…”